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Link to original content: https://pubmed.ncbi.nlm.nih.gov/19142684/
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Comparative Study
. 2009 May;467(5):1271-7.
doi: 10.1007/s11999-008-0698-1. Epub 2009 Jan 14.

Ponseti method: does age at the beginning of treatment make a difference?

Cristina Alves  1 , Carolina Escalda, Pedro Fernandes, Delfin Tavares, M Cassiano Neves
Affiliations
Comparative Study

Ponseti method: does age at the beginning of treatment make a difference?

Cristina Alves et al. Clin Orthop Relat Res. 2009 May.

Abstract

The Ponseti method is reportedly effective for treating clubfoot in children up to 9 years of age. However, whether age at the beginning of treatment influences the rate of successful correction and the rate of relapse is unknown. We therefore retrospectively reviewed 68 consecutive children with 102 idiopathic clubfeet treated by the Ponseti technique in four Portuguese hospitals. We followed patients a minimum of 30 months (mean, 41.4 months; range, 30-61 months). The patients were divided into two groups according to their age at the beginning of treatment; Group I was younger than 6 months and Group II was older than 6 months. All feet (100%) were initially corrected and no feet required extensive surgery regardless of age at the beginning of treatment. There were no differences between Groups I and II in the number of casts, tenotomies, success in terms of rate of initial correction, rate of recurrence, and rate of tibialis anterior transference. The rate of the Ponseti method in avoiding extensive surgery was 100% in Groups I and II; relapses occurred in 8% of the feet in younger and older children.

Level of evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–E
Fig. 1A–E
(A) A child with bilateral clubfeet with previous nonoperative treatment presented at 5 months of age. (B) The parents specifically came seeking Ponseti treatment. (C) The patient was treated by the Ponseti accelerated protocol with four casts and tenotomy. (D) Both feet were corrected. (E) The same patient remained corrected at 4 years of age and the family decided to stop bracing then. The feet remain corrected at the time of this study.
Fig. 2A–F
Fig. 2A–F
(A) A 7-month-old girl presented with unilateral clubfoot with previous casting and percutaneous tenotomy of the Achilles tendon. (B) Posteromedial release was indicated in another institution. (C) The foot was corrected with four casts. (D) There was no need for another tenotomy. (E) The foot remains corrected at 4 years of age and (F) the patient is still compliant with the brace.
Fig. 3A–F
Fig. 3A–F
(A) This 31-month-old child presented with a left clubfoot previously treated with physiotherapy, taping, and casting. (B) At this age, posteromedial release was indicated and the family sought a second opinion. (C) The patient was treated with four casts and a percutaneous tenotomy of the Achilles tendon. (D) Dorsiflexion of both feet is similar. (E) Both feet at 5 years of age. (F) Left foot remains corrected at 5 years of age.
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References

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